Project Summary/Abstract Head and neck malignancies are a serious problem with ~40,000 new head and neck squamous cell cancers (HNSCC) and 13,000 deaths each year in the US alone. Despite advances in therapy, HNSCC recurrences occur in up to 50% of patients with advanced stage disease. Hence, there is a need for targeted adjuvant therapy, similar to Herceptin(R) in breast cancer and Gleevec(R) in multiple myeloma. The mission of this program announcement is to conduct correlative laboratory studies using tumor specimens collected from a multi-institutional clinical trial to identify new biomarkers that can facilitate predictions of clinical outcomes of therapeutic interventions. The main goal of this proposal is to determine whether the degree of Akt/mTOR pathway biomarker activation in tumor-free surgical margins or adjacent mucosa can predict outcomes in a randomized phase 2 clinical trial assessing the efficacy of mTOR-targeted therapy with everolimus in patients with locally advanced HNSCC. Our long-term objectives are to improve survival and to decrease recurrences and second primaries in HNSCC patients by making it a chronic disease using the mTOR inhibitors as targeted adjuvant therapy. There are no validated markers that predict responsiveness to mTOR-targeted therapy and identifying patients that would benefit from therapy is essential to success of targeted agents. The studies proposed in this application will evaluate if the Akt/mTOR pathway components that are over expressed in over 90% of HNSCC and frequently activated in tumor-free surgical margins correlate with the efficacy of mTOR-targeted therapy. To achieve this goal, tumor tissues and tumor-free surgical margins or adjacent normal mucosa of up to 160 clinical trial patients will be analyzed to determine expression and genetic mutations of the Akt/mTOR pathway. Expression levels and genetic mutations will be correlated with the clinical trial patients' survival and recurrence rate. We will also determine whether changes in serum growth factor levels after everolimus therapy correlate with clinical outcomes and can be used as a surrogate marker of drug activity. These studies can potentially identify markers for selecting head and neck cancer patients who will benefit from mTOR-targeted therapy, which would decrease unnecessary toxicity and healthcare costs. Results from this study will be used for subsequent mTOR inhibitor therapy studies in head and neck cancer patients, including a possible phase 3 randomized clinical trial. If successful this therapy could also be used for treatment of squamous carcinomas of other upper aerodigestive tract malignancies such as lung and esophagus.